Supervisor Evaluation of Supervisee (pdf) - University of La Verne

University of La Verne
Psychology Department
Supervisor Evaluation of Supervisee
Student’s Name:__________________________________________________Date:_________________________
Psy 635/636 655/656 680a/680b 681a/681b Semester: Fall __________ Spring ___________
Needs Beginning Good Well Insufficient
Development Grasp Grasp Developed Excellent Information
CASE MANAGEMENT SKILLS:
Follows policies and procedures
of this agency 1 2 3 4 5 X
Cooperative with staff 1 2 3 4 5 X
Manages work load 1 2 3 4 5 X
Professional ethics 1 2 3 4 5 X
Understands legal issues 1 2 3 4 5 X
Punctuality/Attendance 1 2 3 4 5 X
Comments:___________________________________________________________________________________
SUPERVISION
Makes good use of supervision 1 2 3 4 5 X
Evaluates his/her own performance 1 2 3 4 5 X
Accepts feedback from peers and
supervisor 1 2 3 4 5 X
Raises questions 1 2 3 4 5 X
Reports problems 1 2 3 4 5 X
Incorporates suggestions 1 2 3 4 5 X
Keeps case notes & files up-to-date 1 2 3 4 5 X
Comments:
__________________________________________________________________________________
ENGAGEMENT
Ability to be genuine 1 2 3 4 5 X
Demonstrates good listening skills 1 2 3 4 5 X
Maintains working relationship 1 2 3 4 5 X
Demonstrates respect for clients 1 2 3 4 5 X
Demonstrates ability to confront 1 2 3 4 5 X
Demonstrates empathy for clients 1 2 3 4 5 X
Appreciates diversity 1 2 3 4 5 X
Follows client’s processes without
imposing own agenda 1 2 3 4 5 X
Comments:___________________________________________________________________________________
Needs Beginning Good Well Insufficient
1

Development Grasp Grasp Developed Excellent Information
OBSERVATION/DIAGNOSTIC SKILLS:
Assessment ability 1 2 3 4 5 X
Ability to diagnose interactions 1 2 3 4 5 X
Can formulate and set goals 1 2 3 4 5 X
Recognizes limitations and strengths
of clients 1 2 3 4 5 X
Recognizes limitations and strengths
of self 1 2 3 4 5 X
Ability to integrate theory and
diagnosis 1 2 3 4 5 X
Ability to evaluate outcome of
sessions 1 2 3 4 5 X
Comments: ___________________________________________________________________________________
INTERVENTIONS:
Ability to plan interventions 1 2 3 4 5 X
Ability to explain and evaluate interventions
to facilitate desired goals 1 2 3 4 5 X
Ability to select alternative
interventions when needed 1 2 3 4 5 X
Ability to match interventions
to client’s needs 1 2 3 4 5 X
Comments:
__________________________________________________________________________________
TERMINATION:
Demonstrates ability to terminate
appropriately 1 2 3 4 5 X
Ability to use referral sources 1 2 3 4 5 X
Comments:
__________________________________________________________________________________
OVERALL COMMENTS_________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Supervisor’s Signature:____________________________________________Date:___________________________
Agency Name: _________________________________________________ License type & no.:________________
Jan. '02
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